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miércoles, 2 de febrero de 2011

Doctors in a Changing World

Doctors in a Changing World

In 1174, Maimonides was appointed court physician to the rulers of Egypt and spent most of his days at the palace. Concerning his arrival home each day, he wrote: “I partake of some light refreshment, the only meal I eat in twenty-four hours. Then I go to attend to my patients and write prescriptions and directions for their ailments. Patients go in and out until nightfall, and sometimes . . . I am so exhausted I can hardly speak.”

BEING a doctor has always required self-sacrifice. But the world in which doctors practice today is rapidly changing. Their work schedule can still be just as exhausting as that of Maimonides. But are they respected as much as doctors used to be? How have new circumstances affected the doctor’s way of life? And how have recent developments changed the doctor-patient relationship?

A Changed Relationship

Some can still remember the time when a doctor could carry all his remedies in his black bag. There were mixed feelings about doctors in those days, just as there are now. Most were revered for their ability, respected for their rank, and admired for their ethics. At the same time, however, they could be criticized for their fees, berated for their failures, and denounced for their seeming lack of compassion.

Still, many doctors derived deep satisfaction from helping the same family for generations. They used to make numerous house calls, and in country areas they sometimes stayed for a meal or even spent the night when delivering a baby. Many doctors personally made up prescriptions of medicine for their patients. Unselfish physicians provided free treatment for those of little means and were available 24 hours a day, 7 days a week.

Of course, some physicians still work that way, but in many places the nature of the doctor-patient relationship has probably changed more in the past few decades than it has in many centuries. How have these changes come about? Let us look first at the home visit.

What Happened to House Calls?

Visiting patients in their homes used to be the accepted way to practice medicine, and in some lands it still is. But worldwide the custom has been in decline. The Times of India said: “The family doctor with his reassuring bedside manner, intimate knowledge of the family and willingness to make house calls whenever required, is becoming an extinct species in an age of specialists and superspecialists.”

Because of the explosion of medical knowledge, many physicians have specialized and work as part of a group, with the result that patients may see a different doctor each time they are sick. Consequently, many doctors cannot enjoy the long-term relationship with families that they used to have.

The move away from visiting patients at home began a century ago, when doctors started to make greater use of laboratory analysis and diagnostic equipment. In many places health agencies came to see house visits as an inefficient way to use physicians’ time. Today most patients are able to get transportation to visit a doctor’s office. Also, auxiliary and emergency medical services now do work previously handled by doctors.

Changed Status

In today’s world fewer doctors are independent. Medical services are more often provided by government agencies or health-care companies that employ doctors. Many doctors, however, dislike having a third party in the doctor-patient relationship. Such agencies often require doctors to see more patients in less time. “I have to see a patient every seven to ten minutes,” says Dr. Sheila Perkins, a general practitioner in Britain. “And I have to spend much of that time entering information into the computer. There’s little time left to build a relationship with the patient. It can be very frustrating.”

The changing world in which doctors practice is one in which patients have gained more power. At one time the “doctor’s orders” were unchallengeable. But in many lands today, doctors are obliged to inform the patient about treatment options and possible outcomes so that the patient can give informed consent to the treatment. The balance of the doctor-patient relationship has changed. In the eyes of some, the doctor’s image has been reduced to that of a technician.

In our rapidly changing society, a large proportion of physicians are women. Female doctors are often more popular because they are seen as better listeners. So their influence on the profession seems to be to make it more compassionate.

Most people appreciate a doctor who understands patients’ feelings and the stress they live with. But it is reasonable to ask, How many patients understand their doctor’s feelings and the stress he lives with? Doing so could surely improve doctor-patient relationships.

g05 1/22 pp. 3-4

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